Lena Zetterberg

Physiotherapy in cervical dystonia: Six experimental single-case studies

The aim of the study was to explore the outcome of a physiotherapy program targeted to improve the quality of life of people with cervical dystonia (CD) by reducing pain, improving awareness of postural orientation, increasing muscle strength, and reducing the effort of moving the head and neck. In six single case studies, the primary outcome measure for each case was the Cervical Dystonia Questionnaire (CDQ) to measure the impact of the program on the individuals’ quality of life. Secondary outcome measures were identified for the different components of the physiotherapy program: Visual Analogue Scale (pain); Postural Orientation Index (postural orientation awareness); and Movement Energy Index (effort of moving head and neck). Each of the cases had the severity of their problems scored on the Toronto Western Spasmodic Torticollis Scale. The study period was 26 weeks: 2 weeks’ baseline period, 4 weeks’ treatment period, and 20 weeks’ follow-up. All measures except the Movement Energy Index (MEI) and CDQ-24 were taken three times per week for the first 6 weeks of the study and then once at 3 and 6 months. The MEI was taken once a week during the pretreatment and the treatment periods and during the first 2 weeks of follow-up and also after 3 and 6 months of follow-up. The CDQ-24 was taken once in the pretreatment period, once after completion of treatment, once 2 weeks after treatment, and once at 3 and 6 months of follow-up. Five of the six case studies reported an increase in quality of life at 6-month follow-up, as measured on the CDQ-24. Three of the six cases reported a reduction in pain and severity of the dystonia and had improved scores on the postural orientation measure at 6-month follow-up. All six patients had a reduction in the movement energy scores, but this was not significant. The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.

Impact of dystonia on quality of life and health in a Swedish population

Objectives –  Dystonia is often disabling and disfiguring. The aim of the study was to identify factors influencing the impact of dystonia on self‐reported quality of life and health.

Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey.

BackgroundThere is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences.MethodsThe sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey – Revised, Exercise Self-Efficacy Scale, Falls- Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%.ResultsMen were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men.ConclusionsMen were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e.g. men may need more support to be physically active.

Self-perceived non-motor aspects of cervical dystonia and their association with disability

OBJECTIVE To examine the multivariate association between a model of self-perceived non-motor aspects and disability in cervical dystonia. DESIGN A prospective and correlational design with two points of assessment. SUBJECTS All 273 members with cervical dystonia from the Swedish Dystonia Patient Association were invited to participate. METHODS Data were collected with one self-reported questionnaire. The questionnaire was sent by post on two separate occasions. Disability was the primary outcome variable measured by the Functional Disability Questionnaire. RESULTS The questionnaire was completed by 180 individuals (66%) on both occasions. The multivariate association between the non-motor model and disability was statistically significant (adjusted R2 0.46, F(7, 149) = 19.76, p = 0.001). This indicated that 46% of the variance in disability was explained by the non-motor model. Self-efficacy appeared to be the most salient predictor of disability. CONCLUSION The results of this study highlight the need for increasing awareness of self-perceived non-motor aspects among care providers treating patients with cervical dystonia. This presents opportunities for new rehabilitation possibilities that apply a behavioural medicine perspective.

Objective assessment of cervical dystonia: a pilot study

Objectives –  The aims were to characterize the movements in cervical dystonia (CD) by using an estimate of the mechanical power and work involved in the movements and to describe this through a movement energy index (MEI).

Comparison of Polar® RS800CX heart rate monitor and electrocardiogram for measuring inter-beat intervals in healthy dogs

UNLABELLED The aim of the present study was to assess the criterion validity, relative reliability and level of agreement of Polar® RS800CX heart rate monitor measuring inter-beat intervals (IBIs), compared to simultaneously recorded electrocardiogram (ECG) in dogs. METHODS Five continuous minutes of simultaneously recorded IBIs from Polar® RS800CX and Cardiostore ECG in 11 adult healthy dogs maintaining standing position were analyzed. Polar® data was statistically compared to ECG data to assess for systematic differences between the methods. Three different methods for handling missing IBI data were used. Criterion validities were calculated by intraclass correlation coefficients (ICCs) and corresponding 95% confidence intervals (CIs). Relative reliabilities and levels of agreement were calculated by ICCs and the Bland and Altman analysis for repeated measurements per subject. RESULTS Correlation coefficients between IBI data from ECG and Polar® RS800CX varied between 0.73 and 0.84 depending on how missing values were handled. Polar® was over- and underestimating IBI data compared to ECG. The mean difference in log transformed (base10) IBI data was 0.8%, and 93.2% of the values were within the limits of agreement. Internally excluding three subjects presenting IBI series containing more than 5% erroneous IBIs resulted in ICCs between 0.97 and 0.99. Bland and Altman analysis (n=8) showed mean difference was 1.8ms, and 98.5% of the IBI values were plotted inside limits of agreement. CONCLUSION This study showed that Polar® systematically biased recorded IBI series and that it was fundamental to detect measurement errors. For Polar® RS800CX heart rate monitor to be used interchangeably to ECG, by showing excellent criterion validity and reliable IBI measures in group and individual samples, only less than 5% of artifacts could be accepted.

Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial

Abstract Purpose: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals. Materials and methods: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65–85 years) with a stroke 1–3 years previously were allocated to an intervention group (IG, n = 34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n = 33). The primary outcomes were balance (Berg Balance Scale, 0–56 points) and mobility (Short Physical Performance Battery, 0–12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy. Results: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus -0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes. Conclusions: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months. Implications for Rehabilitation A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke. People with poor balance and motor function discontinued the study more often and may require additional support. There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

Systematic review of rehabilitation in focal dystonias: classification and recommendations

Rehabilitation interventions are rarely utilized as an alternative or adjunct therapy for focal dystonias. Reasons for limited utilization are unknown, but lack of conclusive evidence of effectiveness is likely a crucial factor.

Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial

Abstract Purpose: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke. Methods: In this randomized controlled trial, 43 community-dwelling subjects (65–85 years, mean age 73 ± 5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n = 20) or a control group (n = 23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita®). Physical function was measured using the six-minute walk test. Results: Complete case analyses revealed reduced fat mass in the IG compared with the control (−1.5 vs. (0).13% of body weight, respectively; effect size =0.62; p = 0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. −10 m, respectively, effect size =0.69, p = 0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r = 0.48, p = 0.038) in the IG. Conclusions: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke. Implications for rehabilitation   This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:   • Improved walking capacity was associated with a reduction in fat mass.   • IGF-1 is reduced, possibly indicating improved insulin sensitivity.

Level of physical activity in men and women with chronic stroke.

ABSTRACT Introduction: Community-dwelling stroke survivors generally show low levels of physical activity (PA). An improved understanding of the factors influencing participation in PA after stroke is imperative to improve levels of PA. Furthermore, gender differences in PA have received little attention in stroke research. The objective of this study was to examine gender differences in PA, physical functioning and psychological factors and the association between these factors and PA in men and women 1–3-year post-stroke. Materials and methods: A total of 187 community-dwelling individuals with stroke (65–85 years old, 29% women) were included in a secondary analysis based on data from a cross-sectional study. The exclusion criteria were severe cognitive or language dysfunction or dementia. The level of PA was measured by the Physical Activity Scale for the Elderly. Physical function included balance, walking speed and mobility. Psychological factors included depression, health-related quality of life and fall-related self-efficacy. Falls and fear of falling were each measured with a single question. Results: There were no significant differences in PA levels between men and women. In multiple regression analyses, walking speed (p < 0.001) was associated with PA in men, and balance (p = 0.038) was associated with PA in women. Conclusions: The results indicate that strategies to increase PA levels 1–3-year post-stroke could be improved by considering gender-specific factors.